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Biomedical subjects

R Shepherd

Publications and source records attributed to R Shepherd.

At least 91 records · Page 5Linked to original sources

"Cadillac care": advances in technology raise cost-control questions.

With the advancement of medical technology, hospitals are facing a serious problem--providing patients with the most advanced technology available, while at the same time, controlling costs. Trading off between quality and cost Is a difficult decision, and whoever makes that decision--physicians, or the hospital--needs to evaluate all available data to make informed choices. Hospitals that can provide this needed data will better ensure their financial viability while providing patients with the best quality of care.

Capital Expenditures↗

Effects of haemodialysis on taste and thirst.

Fifteen patients undergoing haemodialysis tasted soup varying in salt concentration and apple puree varying in sucrose concentration, immediately before and after dialysis. Matched controls tasted the same foods with a similar interval between tastings. The samples were rated for intensity, and on a relative-to-ideal scale. For the salt, the slopes of the functions plotted against log (concentration) were higher after dialysis than before, whilst the most preferred concentration was lower. There were no effects found for the sweetness ratings or for the controls. Likewise there were no overall differences in the ratings between the patients and controls. Thirst was found to increase on dialysis, and there was a trend of this being higher for the patients than for the controls. The reduction in preferences for salt by dialysis would make compliance with a reduced salt diet easier, but the increase in thirst would make compliance with reduced fluid intake more difficult.

Adolescent↗

Salt and blood pressure: the triangular hypothesis.

If an unselected sample includes individuals whose blood pressure is sensitive to their salt intake and individuals whose blood pressure is not sensitive, then the superposition of these two sub-populations in a scatterplot of individuals' blood pressures against their salt intakes could give a triangular distribution. The non-correlation in the insensitives would obscure the correlation expected in the sensitives. This hypothesis justifies truncation of such data to test for correlation between blood pressure and salt intake among only the individuals in the higher range of blood pressures observed. No criterion of salt sensitivity is needed. The analysis should succeed if salt intake makes a major contribution to hypertension and would be improved if other putative causes were factored out.

Disease Susceptibility↗

Cost accounting in healthcare organizations: who needs it?

There is no question that improved cost information can lead to improved accountability in health care; however, the major proponents of borrowing cost accounting concepts from manufacturing have not gone far enough. They have ignored an important aspect of manufacturing cost accounting that is also a very important prt of hospitals and health care, namely the concern for quality.

Accounting↗

Effects of haemodialysis on taste for salt in relation to changes in blood constituents.

Taste sensitivity and preference for sodium chloride in bread and pea soup were assessed before and after haemodialysis in 12 female chronic renal failure patients. Blood samples were also taken pre- and post-dialysis and analysed for zinc, sodium and renin. The patients demonstrated an increased sensitivity to, and decreased preference for, sodium chloride in both bread and pea soup following dialysis. These taste changes were found to correlate with pre- to post-dialysis changes in the zinc levels in the blood. Patients receiving a more severely sodium-restricted diet showed a greater sensitivity to the taste of sodium chloride in the foods tested. Renin levels dropped in all patients following dialysis, the size of the change correlating with the size of the change in body weight.

Adult↗

Nutrition knowledge, attitudes, and fat consumption.

A questionnaire on nutrition knowledge, attitudes, and consumption of foods contributing highly to fat in the diet of United Kingdom residents was completed by 210 subjects. Personal attitudes were found to be good predictors of consumption and much more important than perceived social pressure from other persons. Women, subjects in the 26- to 45-year age group, and those of higher socioeconomic class tended to have more negative attitudes toward consumption of such foods. Nutrition knowledge was not found to relate to attitudes or to consumption of the foods.

Adolescent↗

Cystic fibrosis.

Explore the source record for details and available documents.

Cystic Fibrosis↗

Attitudes and personality related to salt intake.

A predominantly middle-class female sample of British adults completed questionnaires designed to estimate salt intake and to assess attitudes towards adding table salt to food, along with Cattell's 16PF personality inventory. The attitudes questions were based on the approach suggested by Fishbein and Ajzen, and proved to be good predictors of table salt use. The person's own feeling about table salt use was a better predictor than perceived pressure from other people. Beliefs about adding table salt were closely related to the person's attitude, but only beliefs about taste (not beliefs about health consequences) predicted usage. Beliefs about pressure from doctors and nutritionists/dietitians, but not family, were also related to usage. There was lower usage and more negative attitudes in respondents under 35 years old. Two of the second-order personality factors from the 16PF correlated with salt intake, but appeared to act through attitudes: tough poise (i.e. given to rapid action with insufficient thought) correlated positively with estimated table and cooking salt use; anxiety correlated positively with cooking use, with salt consumed in foods and with estimated total intake. The results suggest that any attempt to reduce salt intake might best be directed at satisfying taste, and not exclusively at augmenting anxiety about the health consequences of salt intake.

Adolescent↗

Changes in salt taste in dialysis and their relationship to blood constituents.

Taste sensitivity for sodium chloride in solution and sensitivity and preference for sodium chloride in bread were measured in 14 male patients undergoing hemodialysis. There was an increase in sensitivity to salt taste following dialysis only when assessed using the bread samples. Patients on a lower sodium diet were more sensitive to salt taste in bread. Although the taste changes were not related to the decreases in serum sodium or to copper, greater increases in sensitivity were related to greater increases in serum zinc during dialysis.

Adult↗

Preferences, attitudes and personality as determinants of salt intake.

Thirty-six female subjects took part in a study involving using pre-weighed table and cooking salt pots, along with complete urine collections for 7 days. Urinary sodium excretion was determined, and was used as an estimate of sodium (salt) intake. Other measures taken were, most preferred concentration of salt in soup, blood pressure, body weight and height, along with questionnaires on general food preferences, attitudes to adding table salt to foods, and the Eysenck Personality Inventory (EPI). Table salt (7 per cent) and cooking salt (8 per cent) were found to account for only a small proportion of total sodium intake, the major part (89 per cent) being from non-discretionary salt present in foods. Subjects, divided on the basis of table salt use and total intake, were found to differ in the most preferred concentration of salt in soup, but not in their sensitivity to variations from their ideal. Table salt use was predicted very well by the individual's attitude, and to a lesser extent by perceived social pressure. The only other variable related to higher table salt use was a lower preference for fruit on the general food preferences questionnaire. The lower preference for fruit was also related to higher total salt intake, which was also predicted by a lower neuroticism score on the EPI. While extraversion was positively related to non-discretionary salt intake, this relationship was not significant for total salt intake.

Adult↗

Estimation of salt intake by questionnaire.

A questionnaire designed to assess salt intake was tested. This involved principal components analysis of responses from 155 subjects to find the underlying components related to the questions. Validation of the questionnaire used 7-day urinary sodium excretion for 33 subjects, along with table and cooking salt usage over 7-days. This gave comparatively good prediction for total intake (r = 0.66) and table salt use (r = 0.70) but not for cooking salt use (r = 0.17). Test-retest reliability for the estimate of total intake was r = 0.75. This method would therefore offer a useful estimate of total intake, especially where group means are required rather than accurate estimates of individual intakes.

Feeding Behavior↗

Fat consumption and attitudes towards food with a high fat content.

A questionnaire on consumption of foods high in fat and attitudes towards these foods was completed by 518 subjects. The attitudes assessment followed the theory proposed by Fishbein & Ajzen (1975). The person's own feelings towards consumption of a type of food was found to be a good predictor of consumption, both for the individual type of food and for an index of the foods combined. Pressure from others was found to be less predictive of consumption. The degree of prediction did not vary between subjects grouped according to sex, age or social class. There were, however, differences in consumption and attitudes between these groups. Females were found to have lower consumption and more negative attitudes towards the high-fat foods. This was also true of the 26-45 year old group compared with both younger and older subjects. No differences were found between different social classes.

Adolescent↗

The relationship between salt intake and preferences for different salt levels in soup.

Two experiments are reported with subjects divided according to questionnaire responses into low and high total sodium intake, and low and high table salt use. The stimuli were tomato soup with varying salt concentrations. In Experiment 1 these were rated for salt intensity, pleasantness and intensity relative to ideal. In Experiment 2 the stimuli were presented in restricted concentration ranges or using a method designed to minimise range bias; relative-to-ideal intensity rating was again used. Subjects with a high total intake were found to prefer higher concentrations of salt assessed both with the hedonic and relative-to-ideal intensity ratings, though not with restricted stimulus ranges. Subjects with high table salt use were found to prefer higher concentrations only when assessed using the hedonic ratings. Sensitivity to salt taste was not found to differ between the groups.

Adolescent↗

Preference and sensitivity to salt taste as determinants of salt-intake.

Total salt-intake was estimated in 33 normal subjects using urinary sodium excretion over 7 days, and table and cooking salt use were measured over the same period. Sensitivity to salt taste was measured for 31 of these subjects using a seven-category rating scale for intensity of saltiness with five concentrations of salt in water, bread and mashed potato. Preferences were assessed using a nine-category hedonic rating scale with the bread and mashed potato to determine the maximally-preferred concentration. No differences were found in the taste measures between subjects divided into high and low intake in terms of total salt-intake or total intake divided by body weight. However, differences were found in sensitivity and preferences between groups divided into high and low table salt use. This may be because the major proportion of total salt-intake arose from salt present in foods and this would not be so open to voluntary control as table salt use.

Adolescent↗

Effects of stimulus context on preference judgements for salt.

An experiment is reported which confirms earlier findings that the range of stimulus concentration affects the estimate of ideal concentration. The method proposed by Booth et al for reducing range bias has been found to give satisfactory results.

Food Preferences↗

Neurogenic faecal incontinence in children with spina bifida: rectosphincteric responses and evaluation of a physiological rationale for management, including biofeedback conditioning.

The rectosphincteric responses of 22 spina bifida (SB) children, aged 3.0 to 11.0 years, with frequent neurogenic faecal incontinence were investigated by clinical and anomanometric techniques and a bowel habilitation programme based on the physiological rationale of timed regular and complete evacuations, regulation of bowel habit and faecal consistency by diet and biofeedback conditioning of rectosphincteric responses. Eighteen patients had perianal anaesthesia, flail anus and absent anorectal reflex, but some degree of (reduced) rectal sensation. Four had reduced perianal sensation and normal to high pressure external sphincter and a megarectum apparently causing an absence of rectal sensation. Twenty were unable to expel the rectal balloon voluntarily. After biofeedback exercises (2-5 sessions) and a home programme of evacuation and diet, 21 of the 22 achieved satisfactory continence over 2-6 months with improved rectal sensation and ability to evacuate voluntarily. This experience suggests that early anorectal evaluation and a comprehensive bowel habilitation programme may be an effective approach to the prevention of disability due to faecal incontinence in SB children.

Anal Canal↗

Persistent post-enteritis diarrhoea in childhood: a prospective analysis of clinical features, predisposing factors and sequelae.

To investigate the incidence, pathophysiology and clinic determinants of persistent diarrhoea (more than seven days) after childhood gastroenteritis, we prospectively evaluated 168 consecutive patients admitted to the Royal Children's Hospital, Brisbane, with gastroenteritis. Thirty-two children (19%) developed persistent diarrhoea; only two-thirds of them had an identifiable aetiological factor, including di- or monosaccharide intolerance (31%), persisting or suspected pathogen (22%) and cow's milk protein intolerance. Computer aided analysis of risk factors in the preceding enteritis showed this complication to be more frequent in young age groups (P less than 0.01) where the patient was less than 10th percentile for weight (P les than 0.02); in Aboriginals (P less than 0.01); where there was a history of previous diarrhoea (P less than 0.001), delayed hospital admission (P less than 0.001) and antibiotic/antidiarrhoeal usage (P less than 0.05); and where there was a bacterial pathogen (P less than 0.001). Severity and outcome were variable with most cases requiring a defined formula diet. These findings provide some insight into the problem of persisting diarrhoea after gastroenteritis, aid identification of at risk patients, and suggest guidelines for management and prevention.

Age Factors↗